目的：观察糖尿病性黄斑水肿(DME)患者注射康柏西普前后黄斑部视网膜浅层毛细血管密度及房水因子的变化，初步探讨康柏西普对DME患者黄斑部微循环的影响。

方法：前瞻性病例对照研究。收集2019-12/2020-12就诊于我院眼科的DME患者10例11眼作为DME组，收集15例无全身系统疾病和眼底疾病的白内障患者作为白内障组以及20例年龄、性别相匹配的视力正常健康人作为对照组。DME组均行每月1次玻璃体腔注射康柏西普总计6次治疗方案。对比对照组与DME患者术前视网膜浅层毛细血管灌注密度(PSCP)、视网膜浅层毛细血管长度密度(VSCP)、中心凹无血管灌注区(FAZ)面积、黄斑中心凹视网膜厚度(CMT)、最佳矫正视力(BCVA)差异。使用液相悬浮芯片技术检测白内障组与DME组患者术前房水因子，对比两组房水因子的差异以及DME组总计6次注射康柏西普后VSCP、PSCP、FAZ、CMT、BCVA和房水因子变化。

结果：术前DME组与对照组之间PSCP、VSCP、FAZ面积、BCVA、CMT均有差异(P<0.01)； 术前DME组与白内障组房水中血管生成素样蛋白4(ANGPTL4)、血管内皮生长因子(VEGF)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)均有差异(P<0.001)； 注射康柏西普5mo DME组PCSP、BCVA均较术前提升，CMT较术前减小(均P<0.05)； DME组房水中ANGPTL4、VEGF、IL-6浓度较基线明显下降(均P<0.05)。DME组患者于注射康柏西普1mo时PSCP改善、BCVA提升以及CMT下降最明显； 注射康柏西普1mo时房水中ANGPTL4、VEGF及IL-6浓度下降最明显。房水中VEGF与CMT变化的绝对值呈正相关。

结论：DME患者注射康柏西普能改善视网膜缺血，降低房水中VEGF及相关因子浓度，有效改善BCVA，减轻黄斑水肿。

AIM: To observe the changes of retina superficial capillary plexus densities and aqueous humor factors in patients with diabetic macular edema(DME)before and after conbercept injection, and to explore the effect of conbercept on macular microcirculation in DME patients.

METHODS: A prospective case-control study was conducted. Totally 11 eyes of 10 patients diagnosed as DME in the Ophthalmology Department of the First Affiliated Hospital of Hainan Medical University from December 2019 to December 2020 were collected as DME group, 15 cataract patients without systemic basic diseases and fundus oculi diseases were collected as cataract group, and 20 age-and sex-matched healthy people with normal vision were collected as control group. All patients in DME group were treated by intravitreal injection of conbercept once a month for a total of 6 times. The retinal perfusion densities of the superficial capillary plexus(PSCP), retinal vessel densities of the superficial capillary plexus(VSCP), foveal avascular zone(FAZ), central macular thickness(CMT)and best corrected visual acuity(BCVA)were compared between the control group and DME patients before operation. The aqueous humor factors in cataract group and DME group were measured by multiplex flow immunoassay. The differences of aqueous humor factors in cataract group and DME group were compared. The changes of VSCP, PSCP, FAZ, CMT, BCVA and factors of aqueous humor in DME group after 6 conbercept injections were compared.

RESULTS: There were significant differences in PSCP, VSCP, FAZ area, BCVA and CMT between DME group and control group before operation(P<0.01); there were significant differences in angiopoietin-like protein 4(ANGPTL4), vascular endothelial growth factor(VEGF), interleukin-6(IL-6), interleukin-8(IL-8)in aqueous humor of DME group and cataract group before operation(P<0.001); PCSP and BCVA were increased and CMT were decreased in DME group after continuous conbercept injection for 6mo(all P<0.05); the concentrations of ANGPTL4, VEGF and IL-6 in aqueous humor of DME group decreased significantly(all P<0.05); patients injected with 1mo conbercept in the DME group had the most obvious improvement of BCVA and PSCP as well as the most obvious decline of CMT; while the ANGPTL4, VEGF and IL-6 in aqueous humor concentration had the most obvious decrease when they were injected with 1mo conbercept; VEGF in aqueous humor was positively correlated with the absolute value of CMT.

CONCLUSION: Conbercept injection in DME patients can improve retinal ischemia, reduce the concentration of VEGF and related factors in aqueous humor, effectively increase BCVA and relieve macular edema.

国家自然科学基金资助项目(No.81860172); 海南省重点研发项目(No.ZDYF2019184)